C-反应蛋白基因多态性与慢性牙周炎伴Ⅱ型糖尿病易感性相关研究靠

目的:初步分析CRP基因多态性与慢性牙周炎伴Ⅱ型糖尿病易感性之间的关系.方法:收集慢性牙周炎伴Ⅱ型糖尿病患者及慢性牙周炎患者的颊黏膜拭子,采用Chelex-100法提取DNA,然后应用PCR-RFLP法检测CRP的基因型分布.并与牙周健康的对照组基因型对比,统计分析慢性牙周炎及Ⅱ型糖尿病的发病是否与CRP+1059G/C的基因多态性有关.结果:慢性牙周炎伴Ⅱ型糖尿病组、慢性牙周炎组与对照组的CRP+1059基因型分布差异无显著性(χ~2=0.223,P=0.994),等位基因频率的分布差异无显著性.3 组受试者中GG基因型最多, GC型次之, CC型最少.各基因型及等位基因频率分布均符合Hardy-Weinberg平衡.结论:本研究未发现中、重度慢性牙周炎,慢性牙周炎伴Ⅱ型糖尿病的易感性与CRP+1059G/C单核苷酸多态性有关.     

伴牙周炎糖尿病患者血清和龈沟液中C反应蛋白的检测及意义

目的:了解龈沟液和血清中C反应蛋白(C-reactive protein,CRP)水平与牙周炎症状况、血糖控制情况的关系.方法:检测伴慢性牙周炎2型糖尿病组、慢性牙周炎组、2型糖尿病组和健康人群组血清和龈沟液中CRP浓度、糖化血红蛋(glycosylated hemoglobin,HbAlc)水平,记录牙周探诊深度(probing depth,PD)和龈沟出血指数(sulcus bleeding index,SBI).采用SPSS10.0软件包进行独立样本t检验和Spearman相关分析.结果:伴慢性牙周炎2型糖尿病组、慢性牙周炎组、2型糖尿病组血清CRP均比正常对照组显著升高(P＜0.01),且伴慢性牙周炎2型糖尿病组血清CRP水平最高,显著高于慢性牙周炎组(P＜0.01)和2型糖尿病组(P＜0.05);4组的龈沟液CRP水平均远低于血清水平,且4组间无显著差异(P＞0.05);血清CRP与龈沟液CRP无相关性(P＞0.05);血清CRP与PD、SBI和HbAlc显著相关(P＜0.01).结论:CRP可能参与了牙周炎和2型糖尿病之间的互相影响;龈沟液CRP水平不能反映牙周病炎症程度和糖尿病病情.     

2型糖尿病伴牙周炎患者牙周炎症程度与血糖水平分析

目的:分析2型糖尿病伴牙周炎患者牙周炎症程度对血糖水平的影响。方法:将213例2型糖尿病伴慢性牙周炎患者,根据根据牙周探诊深度(Probing depth,PD)和牙周附着丧失(Attach ment Loss,AL)的程度分为2组:2型糖尿病伴轻度慢性牙周炎组、2型糖尿病伴中重度慢性牙周炎组,分别测定血清h s-CRP、FPG水平并比较。结果:2型糖尿病伴中重度慢性牙周炎组较2型糖尿病伴轻度慢性牙周炎组血清FPG、hs-CRP水平升高,两组间FPG(t=7.144,P0.001)、h s-CRP(t=13.493,P0.001)差异具有统计学意义,而两组间年龄(t=-0.369,P=0.712)、性别(P=0.819)、饮酒(P=0.697)、吸烟(P=0.223)差异无统计学意义,偏相关分析发现PD与FPG(P0.001)、h s-CRP(P0.001)呈正相关。结论:牙周炎症可能会使2型糖尿病患者FPG、h s-CRP水平升高。     

Ⅱ型糖尿病伴牙周炎病人牙龈组织中VEGF表达及MVD计数的研究

目的:探讨Ⅱ型糖尿病伴牙周炎病人牙龈组织中血管内皮生长因子(VEGF)的表达水平及其作用。方法:选取Ⅱ型糖尿病伴重度牙周炎(DP)病人、单纯重度慢性牙周炎(CP)病人、健康对照者(N)各15例,分别切取牙龈组织,用免疫组化染色方法检测牙龈组织中VEGF表达和MVD计数。结果:DP组牙龈组织中VEGF表达和MVD计数均显著高于CP组和N组(P<0.05);CP组高于N组(P<0.05)。结论:Ⅱ型糖尿病伴重度慢性牙周炎病人牙龈组织中VEGF表达水平和MVD计数明显升高。     

牙周基础治疗对Ⅱ型糖尿病伴牙周炎病人糖基化终产物的影响

目的:观察牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人牙周组织和血清中糖基化终产物(advanced glycation end of products,AGEs)变化的长期影响。方法:诊断为Ⅱ型糖尿病并伴有中等程度以上牙周炎的病人30例,分为进行牙周基础治疗的干预组15例(DM1组),未进行牙周基础治疗的未干预组15例(DM2组);分别在初诊和每次复诊治疗前记录2组的探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、空腹血精、AGEs指标。结果:经牙周基础治疗后,DM1组牙周临床指标均有明显改善;2组AGEs水平有不同程度升高(P<0.05);DM1组第21个月AGFs水平显著低于DM2组,有统计学意义(P<0.05)。结论:牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人的PD、AL、血糖水平、AGEs水平有显著的改善(P<0.05),并且有助于长期稳定。     

TLR4/MyD88信号通路在2型糖尿病合并慢性牙周炎患者中的表达

目的:探讨TLR4/MyD88信号通路在2型糖尿病合并慢性牙周炎发病中的作用。方法:选取2017-02—2018-02在我院内分泌科治疗的2型糖尿病患者157例,其中伴慢性牙周炎患者114例(合并组),单纯2型糖尿病患者43例(糖尿病组)。同期选取慢性牙周炎患者45例(慢性牙周炎组)和健康者40例(健康组)。收集临床资料,采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清中TLR4、MyD88、TNF-α、IL-1β和IL-6水平。结果:合并组和糖尿病组患者FG和HbAlc均高于慢性牙周炎组和健康组(P<0.05),而HDL-C低于慢性牙周炎组和健康组(P<0.05),合并组患者CRP高于糖尿病组、慢性牙周炎组和健康组(P<0.05);合并组牙齿数少于糖尿病组、慢性牙周炎组和健康组(P<0.05),合并组改良出血指数、PD和AL高于糖尿病组和健康组(P<0.05);合并组血清中TLR4、MyD88、TNF-α、IL-1β和IL-6水平均高于糖尿病组、慢性牙周炎组和健康组(P<0.05),糖尿病组和慢性牙周炎组血清中TLR4、MyD88、TNF-α、IL-1β和IL-6水平无差异(P>0.05),而均高于健康组(P<0.05)。结论:2型糖尿病合并慢性牙周炎患者血清中TLR4、MyD88、TNF-α、IL-1β和IL-6水平升高,TLR4/MyD88信号通路介导的炎症反应可能参与了该病的发生及病情进展。     

CRP、ICAM-1、E-selectins在实验性牙周炎大鼠牙周组织中的表达及意义

目的:建立实验性大鼠牙周炎模型,检测C反应蛋白(C reaction protein,CRP)、细胞间粘附分子-1(intercellular adhersion molecule,ICAM-1)、E-选择素(E-selectins)在大鼠牙周组织中的表达及血清中的水平,探讨CRP、ICAM-1、E-selectins在牙周炎发展中的变化。方法:选取纯种6月龄雄性SD大鼠40只,随机分为4组,正常组(A组),4周牙周炎组(B组),8周牙周炎组(C组),12周牙周炎组(D组),每组10只。建立实验性牙周炎动物模型,按计划时间处死实验大鼠,分别检测牙周组织、血清中CRP、ICAM-1、E-selectins的变化。结果:实验性牙周炎随着时间的延长,牙周破坏程度的加深,牙周组织中和血清中的CRP、ICAM-1、E-selectins不断升高,可能进一步加重牙周组织的炎症。结论:CRP、ICAM-1、E-selectins作为牙周炎和心脑血管疾病的共同危险细胞因子,不仅随着牙周炎症的加重而变化,而且能够作为牙周炎导致心脑血管疾病危险因素的证据。     

血栓素B2、6-酮-前列腺素F1α与牙周病和冠心病关系的研究

目的:通过观察冠心病伴中重度牙周炎组、单纯冠心病组、单纯中重度牙周炎组以及健康对照组间血栓素B2(TXB2)和6-酮-前列腺素F1α(6-K-PGF1α)水平的差异,探讨牙周炎与心血管疾病的相互关系.方法:选取经冠脉造影明确诊断为冠心病且伴有中重度牙周炎的病人10名(CP组),单纯冠心病病人10名(C组),单纯中重度牙周炎病人10名(P组)及健康对照组(H组)10名;4组受检者的年龄、性别、体质量指数、吸烟史无统计学差异(P>0.05),高血压史4组间有统计学差异(P<0.05).对所有受检者进行口腔检查,记录其基本资料及相关牙周指标,并抽取清晨空腹静脉血3 mL,采用放射免疫分析方法(RIA)检测其血清中TXB2和6-K-PGF1α水平,进行统计学分析.结果:CP组、C组、P组的TXB2和6-K-PGF1α水平高于H组,差异有统计学意义(P<0.05).结论:冠心病和牙周病病人血清中TXB2和6-K-PGF1α水平升高,提示牙周炎能促进冠心病的发生发展.     

实验性牙周炎对肥胖大鼠血清C反应蛋白及胰岛素抵抗的影响

目的:探讨实验性牙周炎对肥胖大鼠血清C反应蛋白(CRP)及胰岛素抵抗指数(HOMA-IR)随时间的变化.方法:4 周龄SD大鼠(n=35)高脂饲料喂养16 周建立肥胖模型.按肥胖指标筛除5 只,其余30 只肥胖大鼠按1:2比例,随机选取10 只大鼠为肥胖组,20 只肥胖大鼠牙周丝线结扎建立肥胖复合牙周炎模型(复合组),结扎后有4 只大鼠死亡.在牙周结扎前、结扎1 周、4 周3 个时间点眼眶静脉取血,检测空腹血糖及空腹胰岛素,并计算HOMA-IR及β细胞功能指数(HOMA-β);ELISA检测血清CRP水平.结果:牙周结扎1 周后,复合组CRP水平显著升高,在结扎4 周时则逐渐回落(F=7.773,P=0.004).牙周结扎后4 周,复合组HOMA-IR显著高于肥胖组(F=-4.691,P=0.000),HOMA-β显著低于对照组(F=3.672,P=0.002).结论:实验性牙周炎影响肥胖大鼠血清CRP水平;实验性牙周炎会加重肥胖大鼠的胰岛素抵抗状态并下调β细胞功能.     

高敏-C反应蛋白、纤维蛋白原与牙周炎和冠心病的相互关系

目的:通过观察冠心病伴中重度牙周炎、单纯冠心病、单纯中重度牙周炎及健康对照组间炎性指标高敏-C反应蛋白、纤维蛋白原水平的差异,探讨牙周K-if,C,血管疾病的相互关系.方法:选取经冠状动脉造影确诊为冠心病且伴有中重度牙周炎的病人10名(CP组).单纯冠心病病人10名(C组),单纯中重度牙周炎病人10名(P组)及健康对照组(H组)10名.4组受试者的年龄、性别、体质量指数、吸烟史无统计学差异(P>0.05),高血压史在4组间有统计学差异(P<0.05).对所有受检者进行口腔检查,记录其基本资料及相关牙周指标,并抽取清晨空腹静脉血5 mL;采用免疫比浊法测定高敏-c反应蛋白、纤维蛋白原水平.结果:CP组、c组、P组的高敏-c反应蛋白、纤维蛋白原水平高于H组,差异有统计学意义(P<0.05),相关性分析结果显示高敏-c反应蛋白、纤维蛋白原与龈沟出血指数、牙石指数呈正相关,高敏-c反应蛋白还与牙周袋深度呈正相关,且具有统计学意义(P<0.05).结论:牙周炎能引起高敏-c反应蛋白、纤维蛋白原的升高,提示牙周炎作为感染因素可能是心血管疾病的又一危险因素.     

A pilot study into measurements of markers of atherosclerosis in periodontitis

BACKGROUND: Periodontitis may be a possible risk factor for atherosclerosis. The current pilot study explored arterial wall thickness and other variables associated with atherosclerosis in healthy subjects with and without periodontitis. METHODS: Patients with moderate (N = 34) and severe periodontitis (N = 15) and controls (N = 14) were recruited. Intima media thickness (IMT) of the common carotid arteries (CCA), internal carotid arteries (ICA), and bifurcations of carotid arteries (BCA) was estimated bilaterally using B-mode ultrasound. An overall IMT was calculated as the mean of these six measurements. C reactive protein (CRP), fibrinogen, and von Willebrand factor (vWf) were measured in plasma as indicators of systemic inflammation and atherosclerotic disease. Microalbuminuria was determined as a marker of endothelial cell dysfunction. RESULTS: IMT for CCA were 0.64, 0.68, and 0.69 mm for control, moderate, and severe periodontitis, respectively (not significant). IMT for BCA did not vary among groups. IMT of ICA was largest for severe periodontitis (0.81 mm); corresponding values for controls and moderate periodontitis were 0.58 and 0.55 mm, respectively (P= 0.023). Severe periodontitis patients had an overall IMT of 0.76 mm, while moderate periodontitis patients and controls had lower values (0.64 and 0.65 mm, respectively; P= 0.153). After adjusting for potential confounding factors, the increased IMT for ICA in severe periodontitis was also significant (Padj = 0.040). CRP (P= 0.020, Padj = 0.050) and vWf (P= 0.019, Padj = 0.013) were higher in periodontitis than controls; microalbuminuria was not different between groups. Power calculations suggest that a 4-fold expansion of the severe patient and control groups will result in a high chance (power level 80%) that a clinically significant association between the overall IMT and periodontitis will be observed. CONCLUSION: The present pilot study indicates that a full study investigating the relationship between periodontitis and atherosclerosis is warranted.     

牙周非手术治疗对2型糖尿病伴慢性牙周炎患者血糖代谢水平的影响

目的探讨牙周非手术治疗对2型糖尿病伴慢性牙周炎患者牙周状况和血糖代谢水平的影响。方法 2型糖尿病伴慢性牙周炎患者135例,糖化血红蛋白（glycosylated hemoglobin,HbA1c）平均值（7.33±1.42）%,随机分为治疗组和对照组。治疗组接受牙周非手术治疗,对照组暂不接受治疗,只接受口腔卫生宣教。观察2组干预前及干预后3个月、干预后6个月的牙周临床指标,包括探诊深度（probing depth,PD）、菌斑指数（plaque index,PLI）、探诊出血（bleeding on probing,BOP）和血糖代谢指标,包括空腹血糖（fasting plasma glucose,FPG）、HbA1c的变化情况。结果同治疗前相比,治疗组全口平均PD（F=89.956,P=0.000）、PLI（F=82.399,P=0.000）、BOP（F=169.535,P=0.000）随时间推移下降,差异有统计学意义。对照组全口平均PD随时间推移差异无统计学意义（F=3.002,P=0.076）;PLI（F=11.443,P=0.001）、BOP（F=6.537,P=0.008）下降有统计学意义。干预后6个月,组间比较PD（t=-3.318,P=0.001）、PLI（t=-4.354,P=0.000）、BOP（t=-5.868,P=0.000）差异有统计学意义。治疗组FPG（F=4.325,P=0.015）和HbA1c（F=6.654,P=0.003）随时间推移下降,差异有统计学意义;对照组FPG（F=0.215,P=0.756）和HbA1c（F=1.767,P=0.184）随时间推移变化无统计学意义;干预后6个月,两组间FPG（t=-1.386,P=0.171）和HbA1c（t=-1.065,P=0.289）差异无统计学意义。结论牙周非手术治疗能有效控制2型糖尿病伴牙周炎患者的牙周炎症;尚不能认为牙周非手术治疗可以改善糖尿病患者的血糖代谢。     

Serum C‐Reactive Protein and Immunoglobulin G Antibodies to Periodontal Pathogens May Be Effect Modifiers of Periodontitis and Hyperglycemia

Background: Serum C‐reactive protein (CRP) is elevated in both periodontitis and type 2 diabetes mellitus through inflammation. Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been found in periodontal pockets in patients with diabetes. This study examines effect modification by examining the extent to which the associations between periodontitis and hyperglycemia were different by levels of serum CRP and periodontal pathogens. Methods: Blood samples with plasma were evaluated for immunoglobulin G antibodies, CRP, and fasting glucose from 5,731 participants ≥20 years old receiving oral examinations and providing other health‐related data from the National Health and Nutrition Examination Survey III. The study participants were classified into quartiles of probing depth (PD) and clinical attachment level (CAL). The first quartile was the reference. Logistic regression models with survey procedures were used to explore the roles of inflammation levels from serum CRP and periodontal pathogens on the relations with periodontitis, including PD, CAL, and hyperglycemia, and their joint associations with interaction terms. Results: Stronger associations between PD and diabetes existed in people having elevated CRP and titers for P. gingivalis; odds ratios comparing extreme quartiles of PD were 1.31 and 3.40 in the groups with low and high CRP, respectively, and 1.28 and 2.96 in groups with low and high titers for P. gingivalis, respectively. The joint association patterns were similar for CAL and diabetes. Conclusions: The strengths of association between periodontitis and diabetes were stronger in people having elevated serum CRP and P. gingivalis titers. This may suggest that chronic inflammatory conditions could increase the impact of periodontitis on hyperglycemic status.     

Relationship of serum advanced glycation end products with deterioration of periodontitis in type 2 diabetes patients

BACKGROUND: A close relationship between diabetes and chronic periodontitis has been demonstrated. We previously found that Porphyromonas gingivalis with the type II fimA gene is an infectious factor closely associated with the deterioration seen in diabetic periodontitis patients. In the present study, we examined whether other biomarkers are related to the development and deterioration of periodontitis often seen in type 2 diabetic individuals. METHODS: A total of 97 type 2 diabetes patients with and without periodontitis were recruited, and their periodontal and diabetic conditions were analyzed. The ratio (%) of teeth with an attachment loss >5 mm among all teeth in each subject was used as an index of periodontal deterioration. Peripheral blood was tested for levels of glycated hemoglobin (HbA1c), advanced glycation end products (AGEs), C-reactive protein (CRP), and cytokines (tumor necrosis factor [TNF]-alpha and interleukin [IL]-1beta). Subgingival plaque samples were also examined for the occurrences of Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia. RESULTS: Serum AGEs were significantly associated with deterioration of periodontitis, whereas no other serum biochemical marker or bacterial occurrence showed a clear relationship with that condition. CONCLUSION: AGEs may be factors associated with diabetic periodontitis and may be useful as biomarkers that reflect such deterioration.     

2型糖尿病患者慢性牙周炎细菌学研究

目的 :研究 2型糖尿病患者慢性牙周炎的龈下菌群以及菌群变化与血糖、糖化血红蛋白的关系。方法 :细菌学厌氧培养、PCR检测技术。结果 :2型糖尿病患者慢性牙周炎的龈下菌群以厌氧菌为主。产黑菌、二氧化碳噬纤维菌数量与糖尿病患者空腹血糖、糖化血红蛋白之间存在正相关关系。产黑菌、二氧化碳噬纤维菌数量随患者空腹血糖、糖化血红蛋白的升高而增加。结论 :2型糖尿病慢性牙周炎患者龈下菌斑相关菌与血糖、糖化血红蛋白变化密切相关     

����ʡ2�����򲡻�������״�������о�

目的了解辽宁省2型糖尿病患者的牙周状况。方法2007年7—12月在辽宁省糖尿病及代谢综合征的流行病学调查人群中按要求选取2型糖尿病伴牙周炎患者、单纯牙周炎患者、健康人为研究对象,进行问卷调查,检查6颗指数牙的牙周探诊深度(PD)、临床附着丧失(CAL)、龈沟出血指数(SBI)、简化口腔卫生指数(OHI-S)、牙齿松动度(TM),并对胆固醇(TC)、三酰甘油(TG)、空腹血糖(FPG)、葡萄糖耐量试验餐后2h血糖(OGTT 2h PG)进行检测。对上述指标进行统计分析。结果2型糖尿病患者牙周炎患病率为97.7%。排除性别、年龄、居住地、文化程度等因素的影响,2型糖尿病伴牙周炎患者的PD、CAL明显高于单纯牙周炎组。结论2型糖尿病患者牙周破坏严重,口腔卫生教育及防病、治病意识急待加强,同时应严格控制血糖、血脂等全身危险因素对牙周状况的影响。     

口腔卫生指导对2型糖尿病伴慢性牙周炎患者牙周炎症控制及血糖代谢水平的影响

目的探讨口腔卫生指导对2型糖尿病伴慢性牙周炎患者牙周状况和血糖水平的影响。方法 31例2型糖尿病伴慢性牙周炎患者,接受口腔卫生指导后,分别在基线、6周、3个月、6个月、12个月和18个月检测牙周临床指标和血糖代谢指标。牙周临床指标包括:探诊深度、附着丧失、探诊出血、菌斑指数;血糖代谢指标包括:空腹血糖、糖化血红蛋白。结果 31例患者基线、6周、3个月、6个月、12个月和18个月6个时间点的附着丧失量(P=0.003)和探诊出血阳性率(P=0.022)差异有统计学意义;其它指标如探诊深度(P=0.203)、菌斑指数(P=0.087)、空腹血糖(P=0.352)和糖化血红蛋白(P=0.071)的变化没有统计学意义。结论口腔卫生指导可以短期改善2型糖尿病伴慢性牙周炎患者的牙周炎症,但对牙周组织退缩没有更大的帮助,尚不能认为口腔卫生指导对血糖代谢有显著影响。     

牙周非手术治疗对2型糖尿病伴慢性牙周炎患者牙周炎症控制及血清C反应蛋白水平影响的研究

目的探讨牙周非手术治疗对中国广州地区汉族人群2型糖尿病伴慢性牙周炎患者牙周状况及血清C反应蛋白（C-reactive protein,CRP）的影响。方法筛选135例2型糖尿病伴慢性牙周炎患者,以2∶1的比例随机分为治疗组和对照组。治疗组90例接受牙周非手术治疗,对照组45例暂不进行牙周治疗,仅行与治疗组相同的口腔卫生宣教。观察2组患者基线及干预后6个月的牙周探诊深度（probing depth,PD）、附着丧失（attachmentloss,AL）及血清CRP水平的变化情况。结果基线时Logistic回归分析显示平均PD是预测高水平CRP的危险因素（P〈0.05）。相关性分析显示CRP与平均PD相关（r=0.230,P=0.009）,与平均AL不相关（P〉0.05）。治疗后,治疗组PD减少（0.48±0.45）mm,AL减少（0.32±0.51）mm,CRP下降（1.56±5.03）mg/L。治疗前后,治疗组PD（t=10.014,P=0.000）、AL（t=5.888,P=0.000）及血清CRP水平（t=3.157,P=0.000）的差异均有统计学意义;干预前后对照组各项指标变化的差异均无统计学意义（P〉0.05）。两组平均PD（t=-3.318,P=0.001）的差异有统计学意义,而两组间平均AL和血清CRP水平的差异无统计学意义（P〉0.05）。结论牙周非手术治疗可有效改善2型糖尿病伴慢性牙周炎患者的牙周状况,尚不能确认牙周非手术治疗可显著改善2型糖尿病伴慢性牙周炎患者的血清CRP水平。